Search

Background Human brucellosis and recurrent brucellosis is an ever-increasing public health concern, especially in endemic areas like Iran. Nevertheless, little is known regarding the epidemiology and determinants of recurrent brucellosis. Therefore, the objective of this study was to investigate epidemiological patterns and potential determinants of recurrent brucellosis in Hamadan Province during the years 2009–2015. Methods Data on reported cases of new and recurrent brucellosis from 2009 to 2015 were obtained from the provincial Notifiable Diseases Surveillance System at Hamadan University of Medical Sciences. Incidence rates per 100000 were estimated at the county level. Binary logistic regression was used to estimate the effects of background characteristics and recurrent brucellosis. The power of discrimination of the model for recurrent brucellosis was assessed using the area under the curve (AUC). Results Among 7318 brucellosis cases, the total frequency (%) of recurrent cases was 472 (6.45%). The rate of recurrent brucellosis was higher in females, people aged 50 years and over, people with a history of consuming unpasteurized dairy products with no history of contact with animals, and in the winter season. Multivariable logistic regression analysis showed that female sex (adjusted odds ratio (AOR) 1.36, 95% confidence interval (CI) 1.13–1.65), age ≥55 years (AOR 4.15, 95% CI 2.32–7.42), consumption of unpasteurized dairy products (AOR 1.16, 95% CI 0.96–1.40), and winter season (AOR 1.32, 95% CI 1.03–1.71) are potential risk factors for recurrent brucellosis. The final model that involved all the determinants showed moderate discrimination (AUC 0.61). Conclusions Female sex, older age, and winter months were found to be significant determinants of recurrent human brucellosis. Enhanced surveillance systems with an emphasis on these population characteristics will allow effective preventive and protective measures to be implemented and might alleviate the recurrence of brucellosis in the country.

Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease: methodological issues

Background: In the world, it is estimated that 36.9 million people are living with HIV (PLHIV). Tuberculosis (TB) remains as the leading cause of death among PLHIV. This study aimed to determine the predictors of TB among HIV positive patients. Methods: This cross-sectional study was based on the data from 366 patients with HIV/AIDS acquired from 2010 to 2013 in Abadan and Khorramshahr cities, southwest of Iran. Demographic and clinical data were obtained from patients’ medical records in Abadan and Khorramshahr triangular clinics. Univariate and multivariable binary logistic regression models were used to identify TB predictors among HIV/AIDS patients. Results: The prevalence of TB patients was 21.9% among HIV patients. About 57.4% of the patients were below 35 years of age, and most of them (85.5%) were male. Univariate logistic regression showed a statistically significant association between the occurrence of TB and explanatory variables including sex, imprisonment history, HCV and HBV status, addiction, stage of disease, CD4 cell and TLC (Total lymphocyte count) count. In multivariate analysis, being addicted (adjusted OR = 7.03, 95% CI: 1.28, 38.66) and positive HBV (adjusted OR = 4.28, 95% CI: 1.53, 12.00) were associated with incidence of TB after adjusting for age, sex, phase at diagnosis, addiction and HBV status. Conclusions: Addiction and HBV infection can be considered as predictors of incidence of TB in HIV/AIDS patients then early diagnosis of TB especially in higher-risk groups, such as those with addiction and HBV infection is recommended.

Objectives: This study aimed to unveil the effect of depression death and anxiety death on coping style among coronary heart disease (CHD) patients in Tabriz, a city in the Northwest of Iran. Materials and Methods: In this cross-sectional study, 293 coronary heart disease patients were recruited from three hospitals in Tabriz from January to July 2015. Socio-demographic characteristics and CHD clinical history were archived by a checklist. Validated self-administered questionnaires were used to measure death depression, death anxiety, and coping style. The association between death depression and death anxiety with coping style was evaluated, using multivariable linear regression. Results: In this study, the participants were 60 ± 11 years of age. Death depression was most significantly influenced by occupation, and the death anxiety level was affected by the history of hospitalization with CHD. The coping style level was not statistically significant across sociodemographic and CHD clinical history characterises. In death depression, the third quartile was significantly and inversely associated with coping style, compared to reference category; β (95% CI); -1.60 (-2.97 to -0.27), P value = 0.02. Conclusions: Among CHD patients, death depression and death anxiety could be influenced by sociodemographic and CHD history background characteristics, respectively. Death depression could be considered as a determinant for coping style.

Background High-risk individuals for CHD could be diagnosed by some non-invasive and low-priced techniques such as Minnesota ECG coding and rose angina questionnaire (RQ). Objectives The present study aimed at determining the risk of incident CHD according to ECG and RQ besides diabetes and other metabolic risk factors in our population. Methods Participants comprised of 5431 individuals aged ≥ 30 years within the framework of Tehran lipid and glucose study. Based on their status on history of CHD, ECG, and RQ at baseline, all participants were classified to 5 following groups: (1) History-Rose-ECG- (the reference group); (2) History-Rose+ECG-; (3) History-Rose-ECG+; (4) History-Rose+ECG+; and (5) History+. We used Cox regression model to find the role of ECG and RQ on CHD, independent of other risk factors. Results Overall, 562 CHD events were detected during the median of 10.3 years follow-up. CHD incidence rates were 55.9 and 9.09 cases per 1000 person-year for participants with and without history of CHD, respectively. Hazard ratios (HRs) (95% CIs) were 4.11 (3.27 - 5.11) for History + and 2.18 (1.63 - 2.90), 1.92 (1.47 - 2.51), and 2.48 (1.46 - 4.20) for History-Rose+ECG-, History-Rose-ECG+, and History-Rose+ECG+, respectively. RQ and ECG had the same HRs as high as those for hypertension and hypercholesterolemia; however, diabetes showed statistically and clinically more effects on CVD than RQ and ECG. Conclusions RQ in general and, ECG especially in asymptomatic patients, were good predictors for CHD events in both Iranian males and females; however, their predictive powers were lower than that of diabetes.

Differences in the association between high blood pressure and cognitive functioning among the general Japanese population aged 70 to 80 years old: methodological issues to avoid misinterpretation

Prostate cancer (PC) is one of the leading causes of death, especially in developed countries. The human development index (HDI) and its dimensions seem correlated with incidence and mortality rates of PC. This study aimed to assess the association of the specific components of HDI (life expectancy at birth, education, gross national income per 1000 capita, health, and living standards) with burden indicators of PC worldwide.Information of the incidence and mortality rates of PC was obtained from the GLOBOCAN cancer project in year 2012 and data about the HDI 2013 were obtained from the World Bank database. The correlation between incidence, mortality rates, and the HDI parameters were assessed using STATA software.A significant inequality of PC incidence rates was observed according to concentration indexes=0.25 with 95% CI (0.22, 0.34) and a negative mortality concentration index of -0.04 with 95% CI (-0.09, 0.01) was observed.A positive significant correlation was detected between the incidence rates of PC and the HDI and its dimensions including life expectancy at birth, education, income, urbanization level and obesity. However, there was a negative significant correlation between the standardized mortality rates and the life expectancy, income and HDI.

PURPOSE: Speeding and passing are considered as the main human factors resulting in road traffic injuries (RTIs). This study aimed to estimate the population attributable fraction (PAF) of speeding and passing in rural Iran RTIs during 2012. METHODS: The contribution of speeding and passing in RTI related morbidity and mortality was calculated using PAF. The prevalence of speeding and passing was obtained from national traffic police data registry. A logistic regression model was run to measure the association between the above risk factors and RTIs. RESULTS: Speeding accounts for 20.9 and 16.6 percent of rural road- related deaths and injuries, respectively. The corresponding values for passing were 13.5 and 13.4 percent. Considering of the joint effects of these factors, the PAF on road- related deaths is 31.6 percent and 27.8 percent for injuries. CONCLUSION: This study illustrates the importance of speed control and passing as a priority of RTIs in Iran. It is recommended that related laws and legislations should be pursued more seriously, and followed more effectively by law enforcement. Language: en

Background Accurate diagnosis of latent tuberculosis infection (LTBI) is becoming increasingly concerning due to the increasing the HIV epidemic, which have increased the risk for reactivation to active tuberculosis (TB) infection. LTBI is diagnosed by tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). Objectives The aim of the present study was to conduct a meta-analysis of published papers on the agreement (kappa) between TST and QuantiFERON-TB Gold In-Tube (QFT-GIT) tests for diagnosis of LTBI in HIV patient. Methods Electronic databases including PubMed/Medline, Elsevier/Scopus and Embase/Ovid were reviewed up Jan. 2016. We performed a random effect model meta-analysis for estimation of pooled Kappa between the two methods of diagnosis. Meta regression was used for assessing potential heterogeneity and Egger's test was used for assessing small study effect and publication bias. Results The initial search strategy produced 6744 records. Of them, 23 cross-sectional studies met the inclusion criteria and 20 studies entered in meta-analysis. The pooled kappa was and prevalence-adjusted and bias-adjusted kappa (PABAK) were 0.37 (95% CI: 0.28, 0.46) and 0.59 (0.49, 0.69). The discordance of TST-/QFT-GIT+ was more than TST+/QFT-GIT-. Kappa estimate between two tests was linearly associated with age and prevalence index and inversely associated with bias index. Conclusion Fair agreement between TST and QFT-GIT makes it difficult to know whether TST is as useful as the QFT-GIT in HIV-infected patients. The higher discordance of TST-/QFT-GIT+ in compared to TST+/QFT-GIT- can induce the higher sensitivity of QFT-GIT for diagnosis LTBI in HIV patients. Disagreement between two tests can be influenced by error in measurements and prevalence of HIV.

Context Despite considerable attention given to health statistics of road traffic crashes (RTCs), the epidemiological aspects of injuries resulting from RTCs are not fully understood in Iran and other developing countries. The aim of this review was to study the epidemiological pattern and issues arising due to RTCs in Iran. Evidence Acquisition The scope of this study involves data from a broad range of published literature on RTCs in Iran. Data collection for this study was conducted by searching for keywords such as traffic accidents, traffic crashes, motorcycle accidents, motorcycle crashes, motorcycle injury, motor vehicle injury, motor vehicle crashes and motor vehicle accidents, Iran and Iranian in various databases such as Embase, PubMed, Google Scholar, Scopus, Magiran, Iranian scientific information database (SID) and IranMedex. Results This study comprised of 95 articles. It is evident from this review that a large number of severe RTCs occur due to collision of two or more vehicles and most of the victims are males aged between 30 and 39 years. Male pedestrian, drivers and passengers are more likely to be severely injured in comparison to females. One of the most prevalent causes of death among adults involved in the RTCs are head injuries and the majority of deaths occur prior to hospitalization. Mortality rates for RTCs are higher in summer, especially during midnight among all age groups. The most common individual and environmental risk factors associated with RTCs include lack of attention, getting trapped in the car, listening to music, fatigue and sleepiness, duration and distance and negligence of seatbelt usage while driving. Conclusions The findings of the current study will be beneficial in prevention of RTCs and its associated complications and hence will be vital for policy makers, health service managers and stakeholders.

This study aimed to quantify associations of the human development inequality (HDI) index with incidence, mortality, and mortality to incidence ratios for eight common cancers among different countries. In this ecological study, data about incidence and mortality rates of cancers was obtained from the Global Cancer Project for 169 countries. HDI indices for the same countries was obtained from the United Nations Development Program (UNDP) database. The concentration index was defined as the covariance between cumulative percentage of cancer indicators (incidence, mortality and mortality to incidence ratio) and the cumulative percentage of economic indicators (country economic rank). Results indicated that incidences of cancers of liver, cervix and esophagus were mainly concentrated in countries with a low HDI index while cancers of lung, breast, colorectum, prostate and stomach were concentrated mainly in countries with a high HDI index. The same pattern was observed for mortality from cancer except for prostate cancer that was more concentrated in countries with a low HDI index. Higher MIRs for all cancers were more concentrated in countries with a low HDI index. It was concluded that patterns of cancer occurrence correlate with care disparities at the country level.

Background Up to now, there has been no universal consensus on the agreement between the tuberculin skin test (TST) and the QuantiFERON-TB-Gold test (QFT) in the detection of latent tuberculosis infection (LTBI) among high-risk populations. Aims To estimate the agreement between TST and QFT among health care workers (HCWs). Methods A meta-analysis in which all major electronic databases, including Medline, Scopus, Web of Sciences and Ovid, were searched until June 2014. All cross-sectional and cohort studies addressing the agreement between TST and the QFT were included. The extracted data were analysed and the results were reported using random effect models. Results The overall kappa statistic between TST and the QFT was 0.27 [95% confidence interval (CI) 0.22, 0.32] and the adjusted kappa statistic for prevalence and bias was 0.41 (95% CI 0.32, 0.50). The kappa for subjects with and without bacillus Calmette-Guerin (BCG) vaccination was 0.27 (95% CI 0.18, 0.36) and 0.31 (95% CI 0.15, 0.46) respectively. The figures were 0.30 (95% CI 0.16, 0.43) and 0.82 (95% CI 0.74, 0.90) for prevalence-adjusted and bias-adjusted kappa, respectively. Conclusions The overall agreement between TST and QFT in the detection of LTBI among HCWs was poor. After adjusting for the prevalence and bias indices, kappa statistics reached fair agreement. The utility of each of these two tests is dependent on the prevalence and burden of tuberculosis as well as the BCG vaccination status.